Questions raised about disease screening guidelines

By Jordan E. Otero -
The Washington Times -
Thursday, November 10, 2011

In a break with the traditions of modern medicine, researchers and an influential federal advisory panel are concluding that routine testing for some major diseases is doing more harm than good for the patient.

In a string of high-profile announcements in recent weeks, medical professionals have called into question the current screening recommendations for breast cancer, cervical cancer, prostate cancer and cholesterol levels - and sparked a strong reaction from private disease advocacy groups.

“We know we are screening a disease that does not need to be treated” when it comes to prostate cancer, said Dr. Michael LeFevre, a co-chairman of the U.S. Preventive Services Task Force and professor of family and community medicine at the University of Missouri.

In October, the federal advisory panel released new recommendations that healthy men shouldn’t be screened with a widely used PSA blood test for prostate cancer, reversing the current guideline that men should get the test at age 40 and consult with their doctor on future tests. About the same time, major heart organizations began cautioning against extra cholesterol testing.

Critics say that many recommended screening guidelines are expensive, unnecessary, often yield false-positive results, and can bring needless expense and anxiety to patients. But supporters point to numerous examples where a test detected a potentially fatal condition at an early stage, and said screening gives the patient and the doctor that much more information and time to devise the correct course of treatment.

And the debate may just be getting started. A U.S. News and World Report survey found that some 62 percent of the nation’s top internists and some 95 percent of the nations top urologists oppose the recommendation to end screening for prostate cancer.

Two years ago, the federal advisory panel suggested that mammograms for breast cancer are needed only every other year starting at age 50, as opposed to standing recommendations that women get annual checkups starting at age 40. The reception among breast-cancer advocacy groups was not warm.

“Our concern then was, and continues to be, that even with the recommended annual screenings starting at age 40, one-third of women who are eligible will not take advantage of the screening technology,” said Susan Brown, the director of health education at Susan G. Komen for the Cure. “We’re concerned that more groups of women would be more likely to be diagnosed at a higher stage of the disease, which has fewer good options for treatment and higher mortality.”

The federal task force’s guidelines say that annual screening for cervical cancer isn’t necessary and that testing every three years is sufficient. In its recommendations, the task force also recommends doing away with prostate cancer screenings altogether, saying that “convincing evidence demonstrates that the PSA test often produces false-positive results.”

Dr. LeFevre said prostate cancer screening is being conducted for a disease that “doesn’t need to be treated.”

Skeptics say research has found that the test has little effect on death rates and can instead lead to unneeded, expensive treatment plans with side effects such as impotence, incontinence and psychological stress.

But Dr. Thomas Kollmorgen, who practices at the Oregon Urology Institute, argued that extra screening for the disease can’t hurt. He wrote in a recent op-ed for the Eugene, Ore.-based Register Guard that the federal panel was “extrapolating risks of treatment onto screening,” when screening for a disease does not automatically mean receiving treatment.

“There are essentially no risks to screening, and to deny patients the opportunity to participate in decisions regarding their own health care because of concerns regarding treatment they may never get is a scientific bait-and-switch of the worst order,” he wrote.

The Prostate Cancer Foundation said it remains an advocate of routine screening of “informed patients until new American Urological Association clinical guidelines on PSA screening are issued and disseminated,” the group said in a statement. “The PSA test still has a role to play in early detection and treatment for millions of men.”